Awareness About Lifestyle Diseases Associated Risk Factors in School Going Children in Delhi

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Awareness about Lifestyle Diseases Associated Risk Factors in School Going Children in Delhi

ARTICLE · AUGUST 2011

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Jugal Kishore Vardhman Mahavir Medical College and Safd…

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Available from: Jugal Kishore Retrieved on: 11 November 2015 Journal of Nursing Science & Practice Volume 1, Issue 1, July, 2011, Pages 1-9.

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Awareness about Lifestyle Diseases Associated Risk Factors in School Going Children in Delhi Tanu Anand*, Phalguna K., Jugal Kishore & G. K. Ingle

Department of Community Medicine, Maulana Azad Medical College, New Delhi

Abstract

Lifestyle means a pattern of individual practices and personal behavioral choices that are related to elevated or reduced health risk. The diseases which primarily arise from the abnormal lifestyle of a person are grouped under the term “Lifestyle Diseases”. For younger population, the risk of lifestyle disease looms larger. Therefore, this paper aimed to find the prevalence and awareness of lifestyle disease related risk factors in school going children aged 8- 12 years of Delhi. A cross-sectional study was carried out in a government and private school of Delhi. A questionnaire was made to elicit the awareness levels amongst the

school children about the risk factors associated with lifestyle. The specific scores were given to responses of various questions, and data was analyzed using WHO software package Epi Info. A total of 293 participants from both the schools aged 8-12 years were included. 10% students were classified as obese whereas 11% were labeled as overweight. Nearly 39% students were underweight. Around 50% of the participants were consuming soft drinks, chocolates and chips at least 3 times per week. Awareness regarding healthy and harmful eating was quite high amongst the school children. 60% said that parents and family were the most influential source of information about their health. The recommended level of physical activity was being practiced by 55% of the students though more than 90% knew that physical activity is good for health. Almost 90% of the school children were also aware about the addictive nature of smoking and alcohol and that they are harmful to health. Though the awareness level is high, it does not reflect in their eating habits. Opinion of the children with respect to physical activity is not in line with their present practice. Thus, it can be concluded that just imparting knowledge and increasing awareness is not sufficient to prevent the onset of lifestyle diseases amongst school children.

Keywords: Lifestyle diseases, school children, eating habits, Physical activity

*Author for Correspondence E-mail: [email protected]

INTRODUCTION “Lifestyle” originally coined by Austrian determinants to personality makeup to psychologist Alfred Adler in 1929, means influences in the cultural, physical, the way a person lives. It is a pattern of economic, and political environments.1 In individual practices and personal behavioral recent times, these lifestyle patterns have choices that are related to elevated or modified significantly which has lead to reduced health risk. Lifestyles are born of a increase in both physical and mental multitude of causes, from childhood diseases in the world population. Such © STM Journals 2011. All Rights Reserved. 1

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______diseases have been grouped under the term Childhood obesity and overweight has “Lifestyle Diseases.” An alarming number become a global epidemic.4 In one of the of diseases fall under this category- Obesity, most extreme examples from 1976-1980 to Cardiovascular diseases, Depression, 1999-2000, the prevalence of overweight Diabetes Mellitus, Metabolic Syndrome to among children ages 6-11 years doubled, name just a few. More disturbing is the fact from approximately 6.5 percent to 15.3 that a majority of these diseases are inter- percent in the United States. During the related in the sense that one of them can same time period, the prevalence among perpetuate the other leading to a viscous adolescents aged 12-19 years also increased cycle. more than three-fold from approximately 5 percent to 15.5 percent.5,6 Overweight The astonishing rate at which the lifestyle children often become overweight diseases are rising in the population has adolescents and adults and overweight in made them diseases of public health adulthood is a serious health risk.7,8 concern. In 2001, lifestyle diseases However the global problem of childhood accounted for 46% of morbidity and 60% of 2 overweight increasingly extends into the mortality. More than 17 million people die developing world.9 prematurely each year as a result of the global epidemic of chronic diseases, which Several case studies have elucidated the is the leading cause of death in the world relatedness of obesity to other lifestyle today. The World Development Report diseases. There is extensive documentation 2004, showed that 77% and 50% of the of consumption of high energy and fatty years of life lost (YLLs) due to premature foods by the adult population and above mortality were contributed by Non- average level of obesity among them.9 But communicable diseases in high and middle- there is insufficient data available for the income countries. Globally, non- children and adolescents particularly for the communicable diseases contributed highest developing countries like India. Also, burden of YLLs i.e., 612 per lakh population because of the increased prevalence of as compare to 275 per lakh population that is overweight among children and the risk of due to communicable diseases.3 The vast subsequent chronic disease in adulthood, it majority of cases are caused by a small is important to study the correlates of number of known and preventable risk overweight in young children. Therefore, factors. Three of the most important risk this study was undertaken to assess the factors are unhealthy diet, physical inactivity lifestyles of school going children, their and tobacco use. awareness pertaining to the disease and its risk factors and their preferences in light of Most of the world, particularly developing this knowledge. countries like India, is undergoing nutrition transition. Adopting lifestyle from the west MATERIAL AND METHODS has been implicated for rapid rise in the prevalence of lifestyle diseases. It is of It was a school based cross-sectional study. The study participants aged 8-12 years and growing concern as it is affecting the th th pediatric population as well. belonged to standard 6 -8 of a

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______government and a private school which consideration of various factors and chi were randomly selected from the list of square and Fischer’s exact tests was schools in Central Delhi. The sample was calculated to assess any statistical calculated taking 15% prevalence of significance. Data was analyzed using lifestyle diseases (e.g. obesity) accepting WHO software package Epi Info. the worst prevalence of 10% with 95% confidence level which is a maximum of Ethical considerations: As the subjects of 198 but a sample of 293 children (whoever the study were under 18, the head of the present at that time in class) was enrolled in institution or the student’s counselor was the study. requested to give their informed consent to get the information. They were explained Study tool: A questionnaire was designed to the purpose of study and their right to quit elicit the height, weight; eating habits, the the study at any time without giving the child’s awareness about healthy and reasons for doing so. The children’s nutritious diet; the food preferred by the information is dealt with confidentiality. child, and the diet provided by the parents; After getting the information students were understanding of the various triggers that told about the benefits of healthy lifestyles. influence the child’s eating habits (Advertisements, Peer influence, Family RESULTS Background, Family’s Indulgence); physical The study had a total of 293 participants activity, interest in sports, and how often the with an equal distribution from a private child indulges in any particular sport or and a government school in New Delhi. All physical activity; various factors that wean participants were between 8 to 12 years of away the children from sports and physical age. The height and weight of the students activity (TV viewing habits, browsing habits 11 were used to calculate Body Mass Index , etc); views on smoking habits and drinking based on which the 10% students (n=28) habits, their awareness regarding these 2 were classified as obese (BMI ≥ 30 Kg/m ), habits. 11% (n=31) as overweight (BMI 25-29.9 Kg/m2) and 39% (n=114) as Underweight Statistical Analysis: Underweight and 2 overweight children were compared taking (BMI <18.5 Kg/m ) (Figure 1).

Fig 1:Classification of students according to BMI

Obese Overweight Normal Underweight 10% 39% 11%

40%

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Overweight and underweight students were private school. However, no significant compared with respect to socio- association was found with respect to demographic profile. Overweight and physical exercise, gender of the child, obesity was found to be significantly consumption of cold drinks and worrying associated with owning of a car. The fact is (Table 1). that such children were studying in a

Table 1: Comparison of underweight and overweight students with socio-demographic variables and eating habits

FACTORS UNDERWEIGHT OVERWEIGHT P- VALUE (BMI <18.5) % (BMI 24.5-50) SCHOOL Public 47 41 0.002 Government 59 17 SEX Male 63 30 0.758 Female 41 23 SES Owning a Car 39 32 0.034 Not owning a car 65 25 SOFT DRINKS (>3 times/week) 53 21 0.134 Not Drinking 52 36 EXERCISE <2 times/week 56 19 0.056 ≥3-4 times/week 46 32 WORRY Very often 32 20 0.827 Worry sometimes 52 24 Do not worry 10 4

The present eating habits of the school Around 80 to 90% children knew that children was assessed by asking them to tick Green Vegetables, Dal, Milk, Fruits and the foods which they consume at least 3 Vegetables are good for health. Almost times per week. As is evident from the 95% knew that Pizzas, Burgers and French Figure 2 with respect to deleterious foods, Fries are bad for their health. 50% (n=147) of the population consumes soft drinks at least 3 times a week. On being asked how they come to know Chocolates and Chips are also being what is good for their health and what is consumed by almost the same amount of the bad, at least 60% said that parents and population. On the other hand, as far as family were the most influential source of nutritious eating is concerned, around 70 to information. School education was also an 80% of the respondents consumed foods like important source of information as agreed Green Vegetables, Dal, Fruits, Vegetables by 52 % of children. Only 20 % and 10% and Milk at least 3 times a week. of children said media and friends were the source of information respectively. Nearly The respondents were asked to differentiate 65% agreed that they bought or often buy between nutritious and deleterious foods. food items on seeing the advertisements.

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Fig 2: Eating habits of school children 120 100 13 18 22 14 32 80 56 48 50 42 60 78 70 80 78 68 70 87 40 82 78 86 68 20 44 52 50 58 22 30 22 32 30

0 20 Percentage of students

Food Items

Consuming < 3 times/week Consuming atleast 3 time/week

The respondents were asked about the pass time for almost 42% (n=123) amount of leisure time they spent everyday. respondents. 29 % (n=85) preferred More than 70% said that they get around 2 watching TV and 2% (n=6) surfed internet hours everyday for leisure (Figure 3). On for passing time. Only 27% (n=79) of the enquiry about most preferred pass time in total population opted for a Non-Sedentary the leisure hours, video and computer pass time. games came out to be the most preferred Fig 3: Time spent in Leisure activities by the school children

30% 22% No time at all Less than an hour Around 1-2 hour More than 2 hour

45%

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The participants were asked on how often where 21% students were found to be they indulged in some kind of outdoor overweight and obese and 39% of the games or physical activity. 45% (n=132) of children were underweight. The findings of the respondents play rarely or less than 2 this study are corroborated with a study times a week though more than 90% of the done by Chhatwal et al (2004)12 on school respondents gave their opinion as physical adolescents aged 9-15 years in Ludhiana. A activity is good for one’s health. The reason literature review has further elaborated the given for non indulgence in any kind of fact that obesity is rapidly gaining epidemic physical activity was either no time apart for proportions as it reported the prevalence of studies (40%; n=117) or most children obesity to be in the range of 1.5-7.4% and prefer TV/Computer (38%; n=111) than overweight to be 8.5-29%.13 outdoor games. 16% (n=47) showed lack of interest whereas 6 % (n=18) laid the blame In our study, a significant majority of the on bad school facilities. obese and overweight children were from the higher socio-economic strata (families In addition to above, the awareness about which at least own a Car) (p-value=0.016) smoking and alcohol was also assessed. and belonged to private school. This More than 90% of the respondents were of finding also supports the observations made the opinion that smoking and drinking in other studies such as school surveys alcohol are harmful to health or addictive, so done by Mudur 14 in Indian cities which one must not indulge in them. On being have shown that 30% of the adolescents asked whether they have smoked or would from India's higher economic groups were smoke if offered more than 90% answered overweight, and 14 percent of them were in the negative. Also on being asked whether from urban schools. they have ever drunk alcohol or would drink It is well known fact that knowledge is an if they were offered more than 90% 15 answered in the negative. essential ingredient for healthy behavior. In the present study the awareness level At least 8% of the study subjects revealed amongst the children with respect to good that they experience difficulty in sleeping eating habits was very good. This is evident very often, while around 45% experience from the fact that as many as 85 to 90% of sleeping difficulties sometimes. Also, more the respondents understood and voiced the than 35% of the respondents said that they fact that Green Leafy vegetables, pulses, worried often thinking about examinations fruits and milk are nutritious while around or Parent Teacher Meetings. 90% of the participants said that Pizzas, Burgers and French fries consumed on a DISCUSSION regular basis is bad for health. But though the awareness levels were high it did not India is a country in transition and now reflect in their eating habits as more than faces the double burden of coexistent 50% of the population indulged in under-nutrition and over-nutrition. The consuming foods like chips and soft drinks questionnaire based cross-sectional study for more than 3 times a week. These conducted amongst school children findings are more than that found in Health revealed that malnutrition was present Behavior in School Aged Children amongst 60% of the study population © STM Journals 2011. All Rights Reserved. 6

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2001/200216, in which among 11 year age children in the current perspective. This group on an average 25.8% children drank interesting finding is in line with the soft drinks daily. This glaring difference theoretical frameworks such as the Social between the Western World and Indian Cognitive Theory (Bandura, 1986) or scenario is an eye-opener and probably Bronfenbrenner's Ecological Model accounts for growing epidemic of obesity (Bronfenbrenner, 1979), which have particularly among children of the suggested schools as an important developing countries. The study also environmental influence for the dietary highlights the fact that just having behaviors of children and young knowledge does not translate in to adolescents.17 Schools can be an effective practices. and efficient medium to influence the health of school children. We also studied the factors that influence a child’s eating habits. Advertisements play a It was observed that most children (70%) major role in promoting the children’s eating did not get enough time to recreate apart habits as more than 65% of the children from studies. More than 70% said that they admitted to buying and consuming food get almost anywhere between 1 to 2 hours items after being influenced by an everyday. But the choice of recreation advertisement. This has an important mode was largely sedentary. With implication in the form that children are videogames/Computer Games and TV particularly sensitive and responsive to viewing topping the list of most preferred media presentations and try to imitate the options of passing time, it was observed role models which they see on television or that only 27% of the participants indulged other forms of media. Also, children’s in outdoor games as a mode of recreation consumption of media, results in saturation while at least 73% opted for a sedentary with those images and products which may mode of either viewing TV or playing not be so healthy to take thereby increasing Video Games or Browsing the Net. Also, it the likelihood of children getting into was seen that more than 45% of the unhealthy eating habits. This was probably children were playing rarely or less than 2 one of the reasons for children in current times a week, though more than 90% knew study resorting to eat junk food despite that physical activity is an important factor having knowledge about them. for good health. The findings of our study are in consistency with the study done in The fact that the family and parents are Europe where only 38.5% met physical possibly the most important in context of activity guidelines.15 Also, the GSHS development of a child, the context in 200718 revealed that out of 8130 students of which social behavior and attitudes are first 16 classes 8th, 9th, and 10th, only 30.2±3.0% adopted, is reflected in the present study were physically active for a total of at least as most of the students agreed that the 60 minutes per day on all 7 days during the family and parents are the most important past 7 days. The declining level of physical source of information for influencing their activity among the children is alarming as eating habits. School education is also an physical inactivity has been correlated with important instrument which seems to increasing burden of Non-Communicable influence the dietary behavior of the school Diseases (NCDs). © STM Journals 2011. All Rights Reserved. 7

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In a study done by Juulia et al (2003)19 on a co-influencing relationships. It also representative sample of 1290 school highlighted the need of life-skill behavior children aged 8-12 years showed that change intervention rather than just persistent sleep disturbances were found in increasing their level of awareness. 12% of the students. In our study too as much as 8% had sleeping difficulties very Acknowledgement: The authors thank often. Perceived stress was the most Indian Council of Medical Research for significant risk factor for sleep disturbance providing financial assistance in carrying in the study. this research work. Their support is greatly acknowledged. Strengths and limitations of the study: One of the greatest strengths of the study was REFERENCES inclusion of various factors or correlates of the obesity that we tried to study. Secondly 1. Detels R., Mc Ewen J., Beaglehole R. we included more sample than the calculated et al. Oxford Textbook of Public Health sample size. Thirdly, including children –The Scope of Public Health 4th from both public and government school edition. Oxford: Oxford university allowed more representative sample. press. 115-30p. 2. WHO Technical Report Series. Diet, Our study had few limitations as well. Nutrition and the Prevention of Chronic Firstly we use only questionnaire for Diseases. Geneva, WHO. 2003. assessment which is too subjective to bring 3. World Bank. World development report out the clear picture. Also the height and 2004. Making service work for poor weight of the students was self reported people Washington DC, World Bank which may be wrong. Secondly, this was a and Oxford University Press. 2003. cross-sectional study asking about eating 4. Warraich H. J., Javed F., Faraz-ul habits without including the actual intake in Haque M. et al. Prevalence of Obesity terms of energy and nutrients. in school going children of Karachi Plos One 2009. 4(3) e4816-822p. Limitations withstanding, the study 5. Hedley A. A., Ogden C. L., Johnson C. concludes that the high prevalence of both L. et al. “Prevalence of Overweight and Obesity and Underweight reminds of the Obesity Among US Children, predicament that developing country like Adolescents and Adults, 1999-2002” India faces. With the huge lag between JAMA 2004. 291. 2847-850p. awareness levels and actual practice 6. Ogden et al. “Prevalence and Trends in amongst the children, the onus is on the Overweight among US Children and family, school education and the media to Adolescents, 1999-2000” JAMA 2002. mould productive and healthy lifestyle 288. 1728-732p. patterns for the children. There is immense 7. Pi- Sunyer F. X. “Health implications scope for research on this topic especially of obesity” American Journal of to bring into clear focus on the various Clinical Nutrition 1991. 53. 15955- factors that directly and profoundly 16035p. influence the children’s behavioral patterns, 8. Serdula M. K., Ivery D., Coates R. J. et thus providing with a much needed insight al. et al. “Do obese children become into what seems to be an intricate web of © STM Journals 2011. All Rights Reserved. 8

Journal of Nursing Science & Practice Volume 1, Issue 1, July, 2011, Pages 1-9.

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obese adults? A review of the Electronic Journal of Health Education literature” Preventive Medicine 1993. 2008. 11. 119-32p. 22. 167-77p. 16. Currie C., Roberts C., Morgan A. et al. 9. Roya K. “Childhood overweight, obesity Young people’s health in context. and the metabolic syndrome in “Health Behaviour in School-aged developing countries” Epidemiologic Children (HBSC) study” International Reviews 2007. 29. 62-76p. report from the 2001/2002 survey. 10. Popkin B. M., Doak C. M. “The Obesity Europe, WHO. 2004. Epidemic is a Worldwide Phenomenon” 17. Evans A. “Nutrition knowledge, Nutrition Reviews 1998. 56(4) 106-14p. attitudes and practices among nutrition 11. Park K. Park’s textbook of Preventive educators in South Carolina” American and Social Medicine 20th ed. Jabalpur, Journal of Health Studies [Internet] Banarasidas Bhanot publishers. 2009. 2005 [cited 2011 Apr] 20(1). 12. Chhatwal J., Verma M., Riar S. K. Available from: “Obesity among pre-adolescent and http://findarticles.com/p/articles/mi_m0 adolescents of a developing country CTG/is_12_20/ai_n27869277/pg_11/?t (India)” Asia Pacific Journal of Clinical ag=content;col1. Nutrition 2004. 13(3) 231-35p. 18. WHO. GSHS India country fact sheet. 13. Srihari G., Eilander A., Muthayya S., et [Internet]. 2007. [cited 2011 Apr 2]. al. “Nutritional Status of Affluent School Available from: Children: What and How much do we http://www.who.int/chp/gshs/2007. know?” Indian Pediatrics 2007. 44(3) 19. Juulia P. E., Tytti S., Fredrik A. et al. 204-13p. “Four-Year Follow-Up Study of Sleep 14. Mudur G. Asia grapples with obesity and Psychiatric Symptoms in epidemics, World Health Organization. Preadolescents: Relationship of “Obesity: preventing and managing the Persistent and Temporary Sleep global epidemic Geneva” BMJ 2003. Problems to Psychiatric Symptoms” 326(7388) 515p. Journal of Developmental & 15. Shariff Z. H., Bukhari S. S., Othman N. Behavioral Pediatrics 2003. 24(5) 307- et al. “Nutrition education intervention 14p. improves Nutrition of primary school children: a pilot study” International